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Smit MR, Pisani L, de Bock EJE, van der Heijden F, Paulus F, Beenen LFM, Leopold SJ, Huson MAM, Henwood PC, Riviello ED, Walden AP, Dondorp AM, Schultz MJ, Bos LDJ. Ultrasound versus Computed Tomography Assessment of Focal Lung Aeration in Invasively Ventilated ICU Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2589-2597. [PMID: 34172339 DOI: 10.1016/j.ultrasmedbio.2021.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/23/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
It is unknown whether and to what extent the penetration depth of lung ultrasound (LUS) influences the accuracy of LUS findings. The current study evaluated and compared the LUS aeration score and two frequently used B-line scores with focal lung aeration assessed by chest computed tomography (CT) at different levels of depth in invasively ventilated intensive care unit (ICU) patients. In this prospective observational study, patients with a clinical indication for chest CT underwent a 12-region LUS examination shortly before CT scanning. LUS images were compared with corresponding regions on the chest CT scan at different subpleural depths. For each LUS image, the LUS aeration score was calculated. LUS images with B-lines were scored as the number of separately spaced B-lines (B-line count score) and the percentage of the screen covered by B-lines divided by 10 (B-line percentage score). The fixed-effect correlation coefficient (β) was presented per 100 Hounsfield units. A total of 40 patients were included, and 372 regions were analyzed. The best association between the LUS aeration score and CT was found at a subpleural depth of 5 cm for all LUS patterns (β = 0.30, p < 0.001), 1 cm for A- and B1-patterns (β = 0.10, p < 0.001), 6 cm for B1- and B2-patterns (β = 0.11, p < 0.001) and 4 cm for B2- and C-patterns (β = 0.07, p = 0.001). The B-line percentage score was associated with CT (β = 0.46, p = 0.001), while the B-line count score was not (β = 0.07, p = 0.305). In conclusion, the subpleural penetration depth of ultrasound increased with decreased aeration reflected by the LUS pattern. The LUS aeration score and the B-line percentage score accurately reflect lung aeration in ICU patients, but should be interpreted while accounting for the subpleural penetration depth of ultrasound.
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Affiliation(s)
- Marry R Smit
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Technical Medicine Centre, University of Twente, Enschede, The Netherlands.
| | - Luigi Pisani
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Eva J E de Bock
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Technical Medicine Centre, University of Twente, Enschede, The Netherlands
| | - Ferdinand van der Heijden
- Technical Medicine Centre, University of Twente, Enschede, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Ludo F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Stije J Leopold
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Department of Internal Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Michaëla A M Huson
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Patricia C Henwood
- Emergency Medicine Department, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elisabeth D Riviello
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew P Walden
- Department of ICU, Royal Berkshire Hospital, Reading, United Kingdom
| | - Arjen M Dondorp
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Headington, Oxford, United Kingdom
| | - Lieuwe D J Bos
- Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Pezel T, Coisne A, Bonnet G, Martins RP, Adjedj J, Bière L, Lattuca B, Turpeau S, Popovic B, Ivanes F, Lafitte S, Deharo JC, Bernard A. Simulation-based training in cardiology: State-of-the-art review from the French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology. Arch Cardiovasc Dis 2021; 114:73-84. [PMID: 33419690 DOI: 10.1016/j.acvd.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
In our healthcare system, mindful of patient safety and the reduction of medical errors, simulation-based training has emerged as the cornerstone of medical education, allowing quality training in complete safety for patients. Initiated by anaesthesiologists, this teaching mode effectively allows a gradual transfer of learning, and has become an essential tool in cardiology teaching. Cardiologists are embracing simulation to master complex techniques in interventional cardiology, to manage crisis situations and unusual complications and to develop medical teamwork. Simulation methods in cardiology include high-fidelity simulators, clinical scenarios, serious games, hybrid simulation and virtual reality. Simulation involves all fields of cardiology: transoesophageal echocardiography, cardiac catheterization, coronary angioplasty and electrophysiology. Beyond purely technical issues, simulation can also enhance communication skills, by using standardized patients, and can improve the management of situations related to the announcement of serious diseases. In this review of recent literature, we present existing simulation modalities, their applications in different fields of cardiology and their advantages and limitations. Finally, we detail the growing role for simulation in the teaching of medical students following the recent legal obligation to use simulation to evaluate medical students in France.
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Affiliation(s)
- Théo Pezel
- Department of Cardiology, Lariboisiere Hospital, AP-HP, Inserm UMRS 942, University of Paris, 75010 Paris, France; Division of Cardiology, Johns Hopkins University, MD 21287-0409 Baltimore, USA; Ilumens Simulation Department, Paris Diderot University, 75010 Paris, France; French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France
| | - Augustin Coisne
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiovascular Explorations and Echocardiography-Heart Valve Clinic, CHU de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000 Lille, France
| | - Guillaume Bonnet
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Université de Paris, PARCC, INSERM, 75015 Paris, France; Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Raphael P Martins
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Université de Rennes, CHU de Rennes, INSERM, LTSI-UMR 1099, 35000 Rennes, France
| | - Julien Adjedj
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Cardiology Department, Arnault Tzanck Institute, 06700 Saint-Laurent-du-Var, France
| | - Loïc Bière
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Service de Cardiologie, CHU de Angers, Université Angers, 49100 Angers, France
| | - Benoit Lattuca
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Stéphanie Turpeau
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Pôle Cardiologie, Angiologie, Néphrologie, Endocrinologie, Centre Hospitalier d'Avignon, 84000 Avignon, France
| | - Batric Popovic
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiology, CHRU de Nancy, Université de Lorraine, 54000 Nancy, France
| | - Fabrice Ivanes
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Tours University, 37000 Tours, France; Cardiology Department, Tours University Hospital, 37000 Tours, France
| | - Stéphane Lafitte
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Cardiology Department, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Jean Claude Deharo
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Service de cardiologie, hôpital de la Timone, 33000 Marseille, France
| | - Anne Bernard
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Tours University, 37000 Tours, France; Cardiology Department, Tours University Hospital, 37000 Tours, France.
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Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res 2021; 90:524-531. [PMID: 30127522 PMCID: PMC7094915 DOI: 10.1038/s41390-018-0114-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/28/2018] [Accepted: 06/20/2018] [Indexed: 01/29/2023]
Abstract
Lung ultrasound (LUS) is the latest amongst imaging techniques: it is a radiation-free, inexpensive, point-of-care tool that the clinician can use at the bedside. This review summarises the rapidly growing scientific evidence on LUS in neonatology, dividing it into descriptive and functional applications. We report the description of the main ultrasound features of neonatal respiratory disorders and functional applications of LUS aiming to help a clinical decision (such as surfactant administration, chest drainage etc). Amongst the functional applications, we propose SAFE (Sonographic Algorithm for liFe threatening Emergencies) as a standardised protocol for emergency functional LUS in critical neonates. SAFE has been funded by a specific grant issued by the European Society for Paediatric Research. Future potential development of LUS in neonatology might be linked to its quantitative evaluation: we also discuss available data and research directions using computer-aided diagnostic techniques. Finally, tools and opportunities to teach LUS and expand the research network are briefly presented.
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Shin KC, Ha YR, Lee SJ, Ahn JH. Review of simulation model for education of point-of-care ultrasound using easy-to-make tools. World J Clin Cases 2020; 8:4286-4302. [PMID: 33083388 PMCID: PMC7559657 DOI: 10.12998/wjcc.v8.i19.4286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 02/05/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is a powerful diagnostic tool and provides treatment guidelines in acute critical settings. However, the limitation of using POCUS is operator dependent. Appropriate and validated training for acquiring and using skills in practice must be conducted before using POCUS in clinical settings in order to keep patients safe. Simulation education models have been introduced as a way to solve and overcome these concerns. However, the commercial simulator with sufficiently secured fidelity is expensive and not always available. This review focused on the inexpensive and easily made simulators for education on POCUS in critical specific situations related to the airway, breathing, circulation, and disability. We introduced the simulators that used non-infectious materials, with easily transportable features, and that had a sonographic appearance reproducibility similar to human tissue. We also introduced the recipe of each simulator in two parts: Materials surrounding disease simulators (surrounding materials) and specific disease simulators themselves (target simulators). This review article covered the following: endotracheal or oesophageal intubation, lung (A-lines, B-lines, lung sliding, and pleural effusions such as hemothorax), central vein access, pericardial fluid (cardiac tamponade), the structure related to the eyes, soft tissue abscess, nerve (regional nerve block), and skull fracture simulators.
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Affiliation(s)
- Kyu Chul Shin
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, South Korea
| | - Young Rock Ha
- Department of Emergency Medicine, Bundang Jesaeng Hospital, Seongnam-si 13590, South Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, South Korea
| | - Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, South Korea
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